Overview
Prescription Drug Coverage
By enrolling in any of the company’s medical plan options, you are automatically enrolled in prescription drug coverage.
For the Anthem plans, you will be offered prescription drug coverage through Express Scripts, and prescription coverage under the Kaiser HMO plan is provided through the Kaiser Permanente program.
Use this interactive side-by-side plan comparison to understand key differences between the plans.
| Essential CDHP | Standard PPO | Premium PPO | Kaiser HMO (CA Only) | |
|---|---|---|---|---|
| Annual deductible (individual/family) | ||||
| In-network | $2,000/$4,000 | $1,000/$2,000 | $400/$800 | N/A |
| Out-of-network | $4,000/$8,000 | $2,000/$4,000 | $1,200/$2,400 | N/A |
| Rx coinsurance | ||||
| In-network | After deductible Generic Rx: You pay 20% | Generic Rx: You pay 20% | Generic Rx: You pay 10% | Generic Rx: $15 copay retail, $30 copay mail order (for a 100-day supply) |
| Preferred & Non-Preferred Brand Rx: You pay 20% | Preferred & Non-Preferred Brand Rx: You pay 20% | Preferred & Non-Preferred Brand Rx: You pay 10% | Preferred & Non-Preferred Brand Rx: $35 copay retail, $70 copay mail order (for a 100-day supply) | |
| Specialty Rx: 30% to a $500 maximum | Specialty Rx: 30% to a $500 maximum | Specialty Rx: 30% to a $500 maximum | Specialty RX: 20% coinsurance (not to exceed $100) for up to a 30-day supply | |
| Out-of-network | N/A | N/A | N/A | N/A |
| Rx out-of-pocket maximum* | ||||
| In-network | Accrues to the medical plan OOPM |
$2,200 Individual $4,400 Family |
$2,200 Individual $4,400 Family |
N/A |
| Out-of-network | N/A | N/A | N/A | N/A |
*The cap on speciality medications for complex conditions, such as multiple sclerosis and cancer is $500.
SMART 90 Refill Program from Express Scripts
If you take an ongoing medication, such as medication for blood pressure or diabetes, you can get a 90-day supply by mail or from any CVS or Walgreens retail pharmacy.
Not only will this ensure you never miss a dose or have to wait again, but it will also help you save money!
Specialty drug program
When you enroll in the Standard PPO or Premium PPO, your prescription drug coverage features SaveOnSP, a program that can help you save money on certain specialty medications for complex conditions like multiple sclerosis, cancer, and rheumatoid arthritis.
If eligible, SaveOnSP will reach out to you to gather information upon filling your first prescription through Express Scripts.